Giant Renal Pelvic Calculus Removed Laparoscopically in Toto

by Sekhar Bonagiri | Oct 07, 2020 | | 2389 38

Background

66 years old female patient presented with on and off right loin pain and dysuria since 6 years.

Diagnosis and Treatment

Plain CT, KUB (Kidneys, Ureters, Bladder) revealed 8x6cm calculus with 1250 HU (Hounsfield Units), with well-preserved cortical thickness and few air pockets around the right kidney. Urine analysis revealed loaded pus cells and serum creatinine 1.0mg/dl. Urine culture showed Escherichia Coli and was treated according to the urine culture sensitivity. Intravenous Pyelogram (IVP) revealed large renal pelvic calculus in a malrotated right kidney with significant drainage of contrast at 2 hours.

Right double J stenting was done. Laparoscopic pyelolithotomy was done after 3 weeks and stone was removed in completion. Stone weighed 195 grams and measured 9x7cm. The stone analysis by FTIR (Fourier-Transform Infrared Spectroscopy) showed carbonate apatite stone. Patient recovered well and is on follow up since one year.

Giant Renal Pelvic Calculus Removed Laparoscopically in Toto

Discussion

Giant renal pelvic calculus is a rare entity in modern urology practice. In many cases, kidney will become non-functional at the time of presentation. Long-standing stones may predispose to development of squamous cell malignancy in some cases. As continuous urine is required for the stone to grow in size, it is rare for a renal pelvic calculus to grow more than 100 grams as the kidney will be non-functional by that time.

The above is a case of giant renal pelvic calculus in a well-functioning kidney, removed laparoscopically in toto.

Giant Renal Pelvic Calculus Removed Laparoscopically in Toto